Ventricular Tachycardia Ablation in the Elderly: An International Ventricular Tachycardia Center Collaborative Group Analysis

Kairav Vakil, Santiago Garcia, Roderick Tung, Marmar Vaseghi, Usha Tedrow, Paolo Della Bella, David S. Frankel, Pasquale Vergara, Luigi Di Biase, Koichi Nagashima, Shiro Nakahara, Wendy S. Tzou, J. David Burkhardt, Timm Dickfeld, J. Peter Weiss, Jared Bunch, David Callans, Dhanunjaya Lakkireddy, Andrea Natale, William H. SauerWilliam G. Stevenson, Francis Marchlinski, Kalyanam Shivkumar, Venkatakrishna N. Tholakanahalli

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Background Successful ventricular tachycardia (VT) ablation is associated with improved survival in patients with heart failure. However, the safety and efficacy of VT ablation in the elderly, a population with higher competing nonsudden death risk and comorbidities, have not been well defined. Methods and Results The International Ventricular Tachycardia Center Collaborative Study Group registry of 2061 patients who underwent VT ablation at 12 international centers was analyzed. Kaplan-Meier analysis was used to estimate survival of patients ≥70 years with and without VT recurrence. Of the 2049 patients who met inclusion criteria, 681 (33%) patients were ≥70 years of age (mean age, 75±4 years). Among these, 92% were men, 71% had ischemic VT, and 42% had VT storm at presentation. Mean (±SD) left ventricular ejection fraction was 30±11%. Compared with patients <70 years, patients ≥70 years had higher in-hospital (4.4% versus 2.3%; P=0.01) and 1-year mortality (15% versus 11%; P=0.002) but a similar incidence of VT recurrence at 1 year (26% versus 25%; P=0.74) and time to VT recurrence (280 versus 289 days; P=0.20). Absence of VT recurrence during follow-up was strongly associated with improved survival in patients ≥70 years. Conclusion VT ablation in the elderly is feasible and reasonably safe with a modestly higher in-hospital and 1-year mortality, with similar rates of VT recurrence at 1 year compared with younger patients. Successful VT ablation, that is, lack of VT recurrence, is strongly associated with improved survival even in this elderly subgroup.

Original languageEnglish (US)
Article numbere005332
JournalCirculation: Arrhythmia and Electrophysiology
Volume10
Issue number12
DOIs
StatePublished - Dec 1 2017

Bibliographical note

Funding Information:
Dr Vakil has received an investigator initiated research grant from Medtronic Inc. Dr Garcia is a consultant for Surmodics and Osprey Medical. Dr Garcia is a recipient of a career development award (1IK2CX000699-01) from the VA Office of Research and Development and a research grant from Minnesota Veterans Research Foundation. Dr Di Biase is a consultant for Biosense Webster, St. Jude Medical, and Hansen Medical. Dr Nagashima has a fellowship with Medtronic Japan. Dr Tedrow receives honoraria from Medtronic, Boston Scientific, St. Jude Medical, and research grants from Biosense Webster and St Jude Medical. Dr Burkhardt is a consultant for Biosense Webster. Dr Tholakanahalli has received grants from the St Jude Medical foundation and Boston Scientific, research studies for Medtronic, Biotronik, Boston Scientific, and St. Jude Medical and holds patents with PATVJA One LLC. Dr Dickfeld has received a research grant from Biosense Webster and is a consultant for Biosense. Dr Weiss is a consultant for Stereotaxis. Dr Stevenson holds the patent for needle ablation consigned to Brigham and Women’s Hospital. Dr Bella is a consultant for St. Jude Medical and receives honoraria for lectures from Biosense Webster, St Jude Medical, and Biotronik. The other authors report no conflicts.

Publisher Copyright:
© 2017 American Heart Association, Inc.

Keywords

  • Aged
  • catheter ablation
  • heart failure
  • tachycardia, ventricular
  • ventricular fibrillation

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